MEDICARE: MORGAN MUSSELWHITE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT36250	FL

General Provider Information

NPI Number	:	1801400395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN MUSSELWHITE DPT

Provider Business Mailing Address
First Line	:	314 W HAMILTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5425
Country	:	US
Telephone Number	:	904-814-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 CLEVELAND HEIGHTS BLVD STE 101
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2244
Country	:	US
Telephone Number	:	863-664-0007
Fax Number	:	863-644-3377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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